019200513-11-21-2024-15-AS-KHOS-DCWLSJ-20250114080050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200513
Report Date: 11/21/2024
Date Signed: 11/21/2024 03:55:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/12/2024 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20241112144413

FACILITY NAME:	PACIFICA SENIOR LIVING OAKLAND		FACILITY NUMBER:	019200513
ADMINISTRATOR:	GARCIA, ANTHONY		FACILITY TYPE:	740
ADDRESS:	2330, 2350, 2361 E 29TH ST		TELEPHONE:	(510) 534-3637
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94606
CAPACITY:	197	CENSUS:	DATE:	11/21/2024
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Anthony Garcia, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff stealing resident's valuables

INVESTIGATION FINDINGS:

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On 11/21/2024 at 1:30 PM, Licensing Program Analyst (LPAs) Greg Clark and Ardalan Gharachorloo arrived unannounced to conduct an initial 10-day complaint investigation and to deliver findings in regard to the allegations above. LPA met with Executive Director, Anthony Garcia and explained the purpose of the visit.

During the course of the investigation, LPAs interviewed W1, facility staff and R1.

LPAs interviewed S1 who stated that he was aware of an issue with R1’s walker being misplaced. S1 also stated that R1 frequently leaves her walker behind when she is exiting the building or an activity room. S1 further stated that facility staff found a walker they thought belonged to R1 and returned it to her.

"CONTINUED ON LIC9099 C"

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 15-AS-20241112144413

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: PACIFICA SENIOR LIVING OAKLAND	FACILITY NUMBER: 019200513
	VISIT DATE: 11/21/2024

NARRATIVE

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**REPORT CONTINUES FROM LIC 9099**

LPAs interviewed S2 who stated that she was the primary staff person assigned to investigate the missing walker S2 stated that she found a walker in the library that she believed belong to R1. When S2 went to R1’s apartment to return the walker, she found an identical walker folded up behind R1’s door. S2 suspected that R1 took the wrong walker when she was leaving the library. Upon further inspection, S2 discovered there were total of four walkers in R1’s apartment. S2 also stated that R1 frequently leaves the walker behind.

LPAs interviewed R1 in her apartment in the independent living building. R1 told LPAs that she has lived at the facility for over 20 years, and she is very happy with the care that she receives stating “I love it here, they are all so kind”. When LPAs asked R1 specifically about any issues with the walker, R1 stated that she had none and did not recall ever misplacing it.

This agency has investigated the complaint alleging staff stealing resident's valuables. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Gregory Clark	TELEPHONE: 510-285-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC9099 (FAS) - (06/04)

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